Case Overview:
- 4-year-old female patient with total urinary incontinence
- Cloaca with features seen in clocal exstrophy
- Ileocolic junction originally joined bladder
- Distal colon originally joined bladder
- Distal colon originally ended blindly
- Two adjoining bladders
- After an endoscopy 2 weeks later there was reasonable outlet resistance
Follow Up:
- At age 8 years, in 1992, patient returned for evaluation
- Urodynamic study showed leakage at even low pressure
- No reflux
- Normal kidneys
- Further narrowing of bladder outlet and urethra was performed in a 7-hour procedure
- She returned home, a distant rural area, and was on intermittent catheterization by her mother
- No further follow-up for her was proven possible
- The plan, if she was still wet, was to close the bladder neck and make a catheterizable bowel segment on the abdominal wall or umbilicus
- Nearly all patients can be made dry if the surgery and the patient (or family) persist
- Communication about complicated patients has become much less conscientiously pursued in recent times. This defeats long-term follow-up, which is so important for these patients.
THP Source: